Expert: Scott F. Gillman, DC, DACBSP - 2/22/2009

Question
QUESTION: I recently hit my elbow against the weightlifting bar pretty hard.  I've seen a doctor and told me to take Anti-inflammatory medicine and not to worry about it since I had full extension/flexion of my elbow and fingers and there was no swelling.  But I still have need better advice.  It's been 8 days and I've seen improvement.  But I still get pain in my elbow and 4th and 5th fingers every now and then, and my forearm gets a weird sensation every now and then too.  In addition there is pain in my tricep leading up to my neck.  This happens when I type or I have my elbow bent for a long time.  I'm guessing it could be because I hit my radial nerve in my elbow, but why would my neck hurt or is this a separate issue; a seperate neck problem that I have to address.  I'm an 18 year old male.  Please can you elaborate on this because the doctor didn't do a good job.  I hear this is common, but do I still need to see a Chiropractor?

ANSWER: John,

You obviously have some irritation to the ulnar nerve that runs along the medial (ulnar) side of the elbow.  It may simply be entrapped by developing scar tissue from the impact/contusion of hitting the bar. I am assuming your doctor ruled out nerve damage or compression (e.g. you still have grip strength, reflexes, etc).  Find a chiropractor that is certified in Graston Technique and have all the soft tissue around your arm worked through.  There also is a chance that your elbow isn't tracking properly during flexion/extension movement despite the full range.   Have the chiropractor test isometric triceps strength with the wrist in flexion and also with the wrist in extension.  If the chiropractor is not skilled at muscle strength testing, this could be a challenge.  Nevertheless, if wrist flexion or extenstion provokes a weakness to triceps strength, then it is presumed that there is elbow joint malfunction.  Joint manipulation and soft tissue work can fix this. Your neck may be a separate issue or it developed as a result of the faulty upper extremity function.  Either way, the chiropractor will address it and clear out any stuck joints and tight fascia.   Regardless of the treatment provided or the theoretical basis for the treatment, the goal is to experience relief and it should occur within a reasonable amount of time and within a reasonable number of treatment sessions.   For many elbow conditions, it is not uncommon to experience 100% resolve in one treatment session.   If you find a DC that you like and he/she has questions about how to treat an elbow condition, then please have them contact me.  

'Hope this helps.

Dr. G

---------- FOLLOW-UP ----------

QUESTION: Thank you for the quick response.  I apologize because I don't think I put in the details.  My 4th and 5th fingers hurt when I have my elbows bent (every now and then), but most of the time it is actually my index or middle finger that hurts when I am writing something with my elbows bent.  The point of impact was not actually at the ulnar area but rather the area that you can get tennis elbow at.  If I am correct the ulnar nerve is more along the inside of the elbow, but I got hurt on the side of the elbow away from the body (this must be the radial nerve, correct).  I'm thinking that I might have both ulnar and radial nerve entrapment because of inflammation around that area which causes pain when I have my elbows bent.  The odd thing is that I never feel pain in both my 2nd and 3rd digits along with the 4th and 5th.  It usually comes and goes and takes turns on when to attack me.  Will it heal by itself, if so how long do you think it will be?  Is it necessary for me to see a Chiropractor, and how much do you think one will cost (sorry for all the questions, but I need to see how much money I have to gather because I'm in a rather crunch for dineros).  And again, thank you for your time.

Answer
John,

It's not possible to know for sure if you have any entrapment until you undergo physical examination.   Any DC with training in extremity diagnosis and treatment or sports medicine will be able to evaluate your situation and determine how to treat it.  The odds of you having radial and ulnar nerve entrapment are pretty slim.  Soft tissue methods, neuromobilization (you can google this term), and joint manipulation are often the key to resolve.   I cannot comment on costs of care, as this will vary from one doctor to another, and from one region of the country to another.   If you do not have insurance, and you find a top-notch DC, then explain your situation and see if they would offer some sort of discount.  The insurance/HMO industry discounts the services, so it is reasonable to ask if the DC will accept payments that are on par with the insurance industry.  Regarding the point of impact and where your are feeling pain, it is difficult to know what got damaged or how the forces added up in your elbow.  You may not have entrapment at all.   Again, physical examination will reveal the parameters for care.

'Regards,

Dr. G